2004, 08-17 Permit App: BLD-04-07393 MHSPiane
Valley
• BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building* Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
•.4
Street AddreSs:
!q 2; ILI
Assessor's Tax Parcel Number(s): •
5 6 64. y/tev- ..;‘,.e 1 Si-- Add
Legal Description:
_ Exc-ice
13or
PERMIT DESCRIPTION:
0 Building Permit
0 RelocationO
0 Change in Use O Grading EilVlanufactured Home
Tenant Improvement 0 Fire Safety El Other
OWNER/APPLICANT INFORMATION
Owner: 0 tA,
Kt! Jp.y.-41,41-
Phone: 230 -s-if 1 2. Fax:
Address: . Vt 21 4 E, (3LtJtey* e
04---(5 ov-r-lAzt,\,4G4A-- qq 0 2--?
City State Zip Code
0 A4,( C'et'OL'1, 5 Excav,
Fax:
Contractor:
Phone:
Address:
City
State
Zip Code
0 Applicant: 1-1-1vL hDt-,e_s
Phone:• Fax:
—
Address: (co s
1.0tic--ottne q
City/ State Zip Code
Architect:
Phone: Fax:
Address:
City •
State
WA State Contractor License #: Contact:
Zip Code
PER
IT/BU
DING INFORMATION
HEIGHT TQ PEAK
•
MEN 0 S:
# OF STOR ES:. .. .
MAIN FLOOR TO SQ. FTG:
' 2FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
. FINISHED BASEMENT SQ. FTG;
GARAGE SQ: FTG: -
: DECK/COV. PATIO SO. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: .
HEAT SOURCE:
# OF BEDROOMS:
•
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:30%
'
SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
• SYSTEM?
MANUFACTURED HOME
Width: 2 C
Manufacturer:'%
Length:
Year: . 0
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: • D�ate/Time:
Valuation: . Above/Underground Storage Tank Size:
NGTON STATE NON-RESIDENT
Plans Examiner:
Address:
Phone: Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT ❑ -WELDING
Firm Name: Phone:.
Inspector(s):
Fax:
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water.. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued peFfiit inureo the popetky,wow
•
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Print Name „l, (,ik.. �r" 4 / , �' Signature
Method of Payment: (Faxed permit applications .will only be accepted with major bankcard).
❑ Cash ['`Check ❑ Mastercard . • ❑ VISA ❑ Other
• Bankcard #: Expires: VIN#:
Authorized Signature:
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08/19/2004 14:@5 5093241567 SRHD EHS
Aug 19 04 02:35p Oavia tioce;
August 19. 2004
To:
Spokane Regional Health District
Re: Pennit for 19214 E. Buckeye
Tom & Carol Hillebrandt
PAGE 01
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TO 'Whom It May Concern:
We the undersigned owner of the real property at 19214 E. 13uckeye, do stipulate
and agree wc will remove the metal shed on the south side of the stick framed garage on
the above property, on or before September 30, 2004{
Carol Hillebrandt •
L,61`Zf .4162t „ze
AUG 19 2004 1506 5093241567 PAGE.01